title: Remotely controlled mandibular protrusion during sleep predicts therapeutic success with oral appliances in patients with obstructive sleep apnea.
abstract: OBJECTIVE
  The present study addresses the need for a validated tool that prospectively identifies favorable candidates for oral appliance therapy in treatment of obstructive sleep apnea. The objective of the study was to evaluate the ability of a mandibular titration study, performed with a remotely controlled mandibular positioner (RCMP), to predict treatment outcome with a mandibular repositioning appliance (MRA) and to predict an effective target protrusive position (ETPP).
  
  
  METHODS
  A prospective, blinded, outcome study.
  
  
  METHODS
  Standard clinical care with tests performed in the polysomnographic laboratory.
  
  
  METHODS
  Consecutive patients (n = 67) recruited from a sleep center or a dental practice using broad inclusion criteria (age 21-80 years; AHI > 10/h; BMI < 40 kg/m(2)).
  
  
  METHODS
  Therapeutic outcome with a mandibular protruding oral appliance was predicted following a mandibular protrusive titration study in the polysomnographic laboratory using a remotely controlled positioner and prospectively established predictive rules. An ETPP was also prospectively determined for participants predicted to be therapeutically successful with MRA therapy. All participants were blindly treated with a MRA, at either the predicted ETPP or a sham position, and therapeutic outcome was compared against prediction.
  
  
  RESULTS
  At the final protrusive position, standard predictive parameters (sensitivity, specificity, positive and negative predictive values) showed statistically significant predictive accuracy (P < 0.05) in the range of 83% to 94%. The predicted ETPP provided an efficacious protrusive position in 87% of participants predicted to be therapeutically successful with MRA therapy (P < 0.05).
  
  
  CONCLUSIONS
  Using prospectively established rules for interpreting the polysomnographic data, the mandibular titration study predicted mandibular repositioning appliance therapeutic outcome with significant accuracy, particularly with regard to accurately predicting therapeutic success. As well, among the participants predicted to be therapeutically successful with mandibular repositioning appliance therapy, the effective target protrusive position provided efficacious mandibular protrusion in the majority.
authors.affiliation: University of Calgary, Calgary, Canada ; Zephyr Sleep Technologies, Calgary, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Remmers
authors.forename: Shouresh
authors.initials: S
authors.lastname: Charkhandeh
authors.forename: Joshua
authors.initials: J
authors.lastname: Grosse
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Topor
authors.forename: Rollin
authors.initials: R
authors.lastname: Brant
authors.forename: Peter
authors.initials: P
authors.lastname: Santosham
authors.forename: Sabina
authors.initials: S
authors.lastname: Bruehlmann
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008341:Mandibular Prosthesis; D008875:Middle Aged; D017286:Polysomnography; D016037:Single-Blind Method; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome
keywords: Obstructive sleep apnea; mandibular repositioning titration; oral appliance therapy; sleep disordered breathing